ATTEMPT AT ASSESSMENT OF NURSING STUDENTS’ ATTITUDES TOWARDS DEVELOPMENT OF NURSES’ COMMUNICATION SKILLS
PRÓBA OCENY POSTAW STUDENTÓW PIELĘGNIARSTWA WOBEC KSZTAŁCENIA KOMPETENCJI KOMUNIKACYJNYCH W ZAWODZIE PIELĘGNIARKI
Lucyna Iwanow, Mariusz Panczyk, Aleksander Zarzeka, Ilona Cieślak, Mariusz Jaworski, Joanna Gotlib
Division of Teaching and Outcomes of Education, Faculty of Health Sciences, Medical University of Warsaw, Poland
DOI:
ABSTRACT
Introduction. Communication skills of nurses significantly influence the effectiveness of nursing care and treatment provided by an interdisciplinary team. A positive attitude of nursing students towards communication skills training for nurses may influence their willingness to improve such competences.
Aim. The aim of the study was an attempt to assess the attitudes of nursing students towards development of communication skills.
Materials and Methods. A total of 76 students participated in the study. Mean age was 22.7 years. The Communication Skills Attitude Scale, a standardised questionnaire, was used to conduct the study. It comprised 26 statements rated on a five-point Likert scale. In addition, four questions on self-assessment of communication skills with respect to working with patients, their family members, nurses, and other members of a therapeutic team were added to the questionnaire. Descriptive statistics was used to process scores for particular items on the scale and a key was used to calculate the total score.
Results. Nursing students had a positive attitude towards developing communication skills (average total score amounted to 108.9/130). A vast majority of the study participants said that they had to possess good communication skills in order to do their work well (mean score: 4.7/5). Almost all respondents agreed that it was worth acquiring and improving
communication skills on medical studies (mean score: 4.7/5). Students self-assessed their communication skills as medium (mean score: 3.72/5).
Conclusion. The development of a positive attitude and improvement of communication skills at the very beginning of the career pathway may lead to a situation where nurses have better soft skills and are more willing to develop these competences in the future. The present results showing neutral attitudes of students towards developing communication skills and neutral self-assessment of their competences confirmed the need to introduce communication issues into the curriculum for a nursing programme.
KEYWORDS: soft skills, Communication Skills Attitude Scale, students, nursing, communication with patients.
STRESZCZENIE
Wstęp. Umiejętności komunikacyjne personelu pielęgniarskiego to kompetencje, które w istotny sposób wpływają na efektywność prowadzonego w zespole interdyscyplinarnym procesu pielęgnacyjnego i terapeutycznego. Pozytywne postawy wobec nauki kompetencji komunikacyjnych w zawodzie pielęgniarki, w grupie studentów pielęgniarstwa, mogą mieć wpływ na chęć rozwijania takich kompetencji.
Cel. Celem pracy była próba oceny postaw studentów pielęgniarstwa wobec kształcenia kompetencji komunikacyjnych.
Materiał i metody. W badaniu udział wzięło 76 studentów. Średnia wieku wyniosła 22,7 lat. Badania prowadzono przy użyciu standaryzowanego kwestionariusza Communication Skills Attitude Scale. Kwestionariusz składa się z 26 stwierdzeń, ocenianych w pięciostopniowej skali Likerta. Dodatkowo autorzy dołączyli do kwestionariusza cztery pytania dotyczące samooceny umiejętności komunikacyjnych w aspekcie pracy z pacjentem, jego rodziną, personelem pielęgniarskim oraz pozostałymi członkami zespołu terapeutycznego. Uzyskane wyniki dla poszczególnych pozycji skali opracowano metodami statystyki opisowej, a sumaryczną punktację zliczono według klucza.
Wyniki. Studenci pielęgniarstwa prezentowali pozytywne postawy wobec nauki kompetencji komunikacyjnych (średni wynik sumaryczny wyniósł 108,9/130). Zdecydowana większość badanych twierdziła, że aby dobrze wykonywać pracę pielęgniarki muszą posiadać dobre umiejętności komunikacyjne (średni wynik 4,7/5). Niemal wszyscy ankietowani byli zdania, że na studiach medycznych warto zdobywać i rozwijać umiejętności komunikacyjne (średni
wynik 4,7/5). Studenci ocenili średnio swoje umiejętności komunikacyjne (średni wynik 3,72/5).
Wniosek. Kreowanie pozytywnych postaw oraz rozwijanie umiejętności komunikacyjnych na początku ścieżki kariery może skutkować lepiej rozwiniętymi kompetencjami miękkimi wśród personelu pielęgniarskiego oraz większą chęcią do rozwijania tych umiejętności w przyszłości. Prezentowane wyniki wskazujące na neutralne postawy wobec nauki umiejętności komunikacyjnych oraz neutralną ocenę swoich kompetencji przez studentów potwierdzają zasadność uzupełnienia programu nauczania na studiach pielęgniarskich o treści z zakresu komunikacji.
SŁOWA KLUCZOWE: kompetencje miękkie, Skala Oceny Postaw Wobec Nauki Umiejętności Komunikacyjnych, studenci, pielęgniarstwo, komunikacja z pacjentem.
Introduction
Both Polish and world scientific literature presents numerous publications emphasising that effective communication between patients and doctors as well as members of a therapeutic team and family members is crucial for providing high-quality care [1-10].
Owing to their nature, soft skills, including communication ones, are amongst the most desired competencies on the labour market [11][Street Jr., 2013, Designing a curriculum for communication skills training from a theory and evidence-based perspective]. Employees look for employers with an ability to communicate effectively, establish contacts, maintain relations, work in a team, manage other people, as well as influence others, motivate them and develop their potential [8, 11, 12].
Proper communication, both between interdisciplinary team members and between medical personnel and patients as well as their family members is essential for the correct course of treatment. In addition, communication skills of healthcare professionals influence the image of a healthcare entity and increase patient satisfaction with and quality of healthcare provided [6].
In spite of the important role of soft skills, the available literature indicates that the level of these skills among nurses is insufficient [1, 2]. The attention is also drawn to the need for better mutual communication between nurses and doctors as well as other members of a therapeutic team [1, 2, 4, 9, 13].
Available scientific reports point to the conclusion that it is necessary to include in the curriculum the training in soft skills as well as development of a positive attitude towards
acquiring them [14-16]. It is important that students develop a positive attitude by a properly designed teaching process towards learning communication skills. This may result in the willingness to develop these skills in the future, e.g. by participating in post-graduate training courses.
At present, CSAS is the most popular standardised tool used for measuring the attitude towards learning communication skills [17]. Due to good psychometric parameters and an access to numerous language versions, this scale can be considered an international tool, enabling a comparison of results between various countries and students of different medical and health sciences [18-33]. CSAS has been developed by Rees et al. [17] in order to evaluate attitudes of students of medicine towards learning communication skills. The tool was supposed to help to modify the curriculum for medical degree programmes so that there were more courses dealing with soft skills in a broader sense [17]. Molinuevo et al. [19] have adapted CSAS to the needs of nursing students in Catalonia. It is an important feature of CSAS that there are several validated language versions of this scale, which makes it possible to compare results of various studies conducted by different researchers in different countries [17, 27, 29, 32-34].
Since there is no Polish language version of CSAS, the present authors decided to prepare a pilot version of the scale measuring attitudes towards communication skills learning, based on an Anglo-Saxon version of CSAS and adapt it to study attitudes of nursing students.
Aim of study
The aim of the study was an attempt to assess the attitudes of nursing students towards developing communication skills.
Materials and Methods
The pilot study enrolled a total of 76 nursing students (75 women). Mean age was 22.7 years (median: 22; min. 19, max. 55, SD: 4.14). Students of Warsaw Medical University constituted a vast majority of the entire study group (61 persons). Nine students of Ludwik Rydygier Collegium Medicum in Bydgoszcz (Nicolaus Copernicus University in Toruń) and six students of the University of Rzeszów also took part in the study. 45 respondents were first-cycle degree students, 19 of whom were first-year students, 13 - second-year students, and another 13 - third-year students. As many as 31 persons were second-cycle degree students, including 16 first-year students and 15 second-year students. Nearly three-quarters of the
respondents admitted they had never had any experience with any training in communication skills.
The study was conducted in March 2017. Participation in the study was voluntary and anonymous. The tool was made available to the respondents on a social networking site in an electronic form using the Google form.
The present authors received an opinion of the Ethical Review Board of Warsaw Medical University that an approval for the study with reference to the objective of the present study was not necessary [41].
The study was performed using a survey technique with a standardised questionnaire of Communication Skills Attitude Scale [17]. The questionnaire comprised 26 statements concerning the significance of communication skills in the nursing profession rated on a five-point Likert scale (1 – strongly disagree, 5 – strongly agree). The scale was divided into two subscales: positive (PAS) and negative (NAS). 13 statements expressed an approving attitude towards communication skill in the nursing profession, while the other 13 - on the contrary. The attitude towards learning communication skills was assessed (whether it is positive or negative) on the basis of a total score, whereas answers on the NAS scale were recoded before being added together. The total score available for completing the questionnaire was 130.
Four additional questions concerning self-assessment of communication skills were added by the present authors to the CSAS. These questions were rated on a five-point Likert scale as well, with 1 referring to ‘very poor’ and 5 meaning ‘very good’. The respondents were asked to assess their competence in regard to collaboration with patients, family members of patients, other nurses and nursing students as well as other members of a therapeutic team.
Descriptive statistics was used to process scores for particular items on the scale and a key was used to calculate the total score. The MicrosoftExcel program was used for calculations.
Results
Nursing students participating in the study had a positive attitude towards communication skills (average total score amounted to 108.9/130). A vast majority of the respondents agreed that they needed to have good communication skills in order to be able to do their work well (mean score: 4.7/5). Although the students did not agree with a statement that the development of communication skills was easy (mean score: 3.0/5), most of them agreed that it would be useful to acquire them during the course of study (mean score: 4.4/5).
Over three-quarters of the respondents said that communication skills significantly influenced the process of building respect for patients among nurses and improve communication between nursing staff and patients. A vast majority of the respondents admitted that the acquisition of communication skills would be useful for teamwork.
See Table 1 for detailed results relating to attitudes of students towards the acquisition of communication skills in nursing.
Table 1. Attitudes of students towards acquiring communication skills in the profession of nurse
Attitude Average Median SD
PAS
4. Developing my communication skills is just as important as
developing my knowledge of medicine 4,7 5 0,46
5. Learning communication skills has helped or will help me
respect patients 4,2 5 1,18
7. Learning communication skills is interesting 4,1 4 0,84 9. Learning communication skills has helped or will help
facilitate my team-working skills 4,8 5 0,44
10. Learning communication skills has improved my ability to
communicate with patients 4,6 5 0,49
12. Learning communication skills is fun 3,3 3 0,98
14. Learning communication skills has helped or will help me
respect my colleagues 3,5 4 1,05
16. Learning communication skills has helped or will help me recognise patients' rights regarding confidentiality and informed consent
3,9 4 0,82
18. When applying for medicine, I thought it was a really good
idea to learn communication skills 2,8 3 1,02
21. I think it is really useful learning communication skills on the
medical degree 4,4 4 0,60
22. My ability to pass exams will get me through medical school
rather than my ability to communicate 3,4 4 0,85
23. Learning communication skills is applicable to learning
medicine 3,4 3 0,78
25. Learning communication skills is important because my
ability to communicate is a lifelong skill 4,3 4 0,61
NAS
1. In order to be a good practitioner I must have good
communication skills 4,7 5 0,46
2. I cannot see the point in learning communication skills 1,3 1 0,54 3. Nobody is going to fail their medical degree for having poor
communication skills 2,3 2 0,77
6. I have not got time to learn communication skills 2,4 2 1,16 8. I can't be bothered to turn up to sessions on communication
skills 1,9 2 0,82
11. Communication skills teaching states the obvious and then
complicates it 3,6 4 1,02
13. Learning communication skills is too easy 3,0 3 1,12 15. I find it difficult to trust information about communication
skills given to me by non-clinical lecturers 2,3 2 1,11 17. Communication skills teaching would have a better image if it
sounded more like a science subject 3,4 3 1,14
19. I don't do not need good communication skills to be a
practitioner 1,8 2 0,72
20. I find it hard to admit to having some problems with my
communication skills 2,9 3 1,26
24. I find it difficult to take communication skills learning
seriously 2,5 3 1,01
26. Communication skills learning should be left to psychology
students, not medical students 1,6 1 0,81
Average score of the NAS: 57,6/65 Source: author’s own analysis
Students self-assessed their communication skills as medium (mean score: 3.7/5). Their ability to communicate with patients was rated highest (4.5/5), followed by the ability to communicate with other nurses (3.8/5), members of an interdisciplinary team (3.7/5), and family members of patients (3,4/5).
Discussion
The existing healthcare model as well as management of medical facilities put great emphasis on soft skills among nursing staff, understood in their broad sense, communication skills included. A number of publications emphasise the importance of communication among
nurses as well as between nurses and their patients and family members of patients [5, 7]. They also indicate that the level of communication between therapeutic team members is unsatisfactory. This is one of the main reasons for medical errors, thus affecting the safety of patients and medical personnel [5, 7, 9, 42, 43].
Despite a positive attitude of the respondents towards learning communication skills revealed in the study, the mean score of all answers amounted to 3.2/5. This demonstrated the neutral attitude towards communication skills. Nursing students participating in a pilot study also assessed their communication skills as neutral (mean score: 3.7/5). The present results confirmed the rationale for introducing elements of teamwork composed of students of different majors as early as at the beginning of their university education. The aim of this is to create a positive attitude and development of communication skills in setting up therapeutic teams. The study group saw the link between competence in communication and the process of building respect in teamwork and in working with patients. It has to be recognised that students agreed with a statement that it was difficult to acknowledge gaps in soft skills.
The CSAS was initially designed to assess students of medicine but now the scale has been validated also for students of dentistry [32, 38], nutrition [20], school pedagogics, [22] and resident doctors [34]. There is also one language version - Catalonian - adjusted to students of nursing [19]. The tool has been validated so far in 16 countries on four continents. It is available in 11 language versions. At present, in addition to the original English language version, the following versions were validated in Europe: Norwegian [31], Portuguese [34], Catalonian [19], German [29], Hungarian [40] , and Finnish [18].
The present authors did not find any publications in the Polish literature discussing students' attitudes towards learning communication skills. However, there is a number of articles relating to issues concerning soft skills among nurses [5-8, 11, 42, 44]. A study by Kekus et al. [5] demonstrated that interpersonal communication constituted one of the basic skills in modern nursing. The authors referred to the World Health Organisation which had showed that good interpersonal communication skills represented one of five core competencies leading to a healthy and happy life. Lipińska et al. [44] emphasised the importance of communication with patients as a fundamental part of care and satisfaction with services provided. It was also demonstrated that most nurses had problems with communicating with terminally ill patients. A study by Surmacka and Motyka [7] on communication problems in clinical practice showed how the need for safety was important for patients. According to hospital patients, this need was often neglected because of
communication errors. In addition, it was found that communication skills of medical personnel remained at a very low, unsatisfactory level.
The present study revealed that the respondents saw a need to develop communication skills in medical professions. The study participants presented a positive attitude towards learning communication skills in a number of professional activities of nurses, not only directly related to a conversation, but also to building respect for patients and other members of a therapeutic team. The students participating in the study saw the link between the development of communication skills and good learning outcomes and professional skills.
The present study is the first one based on the Polish language version of CSAS. In addition, this is one of the few publications in the world analysing attitudes of nursing students. The present study is a pilot that starts a series of articles regarding the use of the Polish language version of the Communication Skills Attitude Scale for nurses and nursing students.
Attitudes of students of medical science and health science towards learning communication skills are often analysed in the world literature with the use of CSAS [19, 23-25, 32, 33, 38]. Rees et al. [39], authors of the original tool, examined 225 first-year students of medicine. In addition to the original questionnaire comprising 26 statements, self-assessment questions on communication skills were added to the questionnaire. The median of the results amounted to 3, which means that the students did not have a clearly defined view on communication skills. In the present study the median of answers provided by students on their attitudes towards learning communication skills was 3, which is similar to the one obtained by Rees et al. [39]. Most students (92%) believed that their communication skills needed improvement and that courses in communication at the faculty of medicine were essential. Those skills should be taught during clinical classes when working directly with patients and the remaining members of medical and interdisciplinary teams. Additionally, Rees et al. [39] noticed that gender, language, and ethnic origin influenced differences in the results. Women participating in the study demonstrated fewer negative attitudes towards communication skills than men [39].
Cleland et al. [23] analysed 467 first-, second-, and third-year students of medicine and compared their attitudes. In this study, additional self-assessment questions on communication skills were also added to the original tool. It was observed that the higher the year of study, the lower the return rate and the more negative attitudes towards communication skills. Moreover, a correlation between a gender and the attitude towards communication skills was also found [23]. As in the study by Rees et al. [39], women adopted
a more positive attitude towards communication skills. Additionally, unlike men, women were more neutral in assessing their communication skills. It was recommended to analyse students' attitudes over the entire course of study, including postgraduate training, arguing that the present level of professional skills may influence attitudes towards communication skills [23]. Due to a small sample and a female-dominated study group in the present study, it was impossible to perform analysis in terms of the gender and the year of study.
A study by Khashab conducted among 470 fourth- and fifth-year students of medicine was another one analysing attitudes towards communication skills with the use of CSAS [21] . As in the case of the two aforementioned studies, the author of this one added to the original questionnaire a number of self-assessment questions on communication skills. Additionally, the respondents were asked whether they had participated in communication courses in the past. 95% of the study participants believed that their communication skills needed improvement. However, the respondents showed a different trend than those in the study by Cleland [23]. In the study by Khasab, [21] the higher the year of study, the more positive attitude of students towards communication skills. In addition, no correlations were found between the gender and the attitude towards skills [21]. The present results also demonstrated a need for improvement of communication skills. The mean score of self-assessment of communication skills of students participating in the study amounted to 3.7. Moreover, the respondents could not take a position that learning communication skills exerts an impact on learning medicine (mean score: 3.4/5).
Limitations of the study results
Interpretation and drawing conclusions on the basis of the present results are subject to certain limitations that need to be taken into account when assessing these outcomes. The study was conducted with a small group of nursing students. Most respondents studied at the same university, hence the study group cannot be considered as representative for the entire population of students of this particular major. This was a pilot study and its results encourage to perform a national study with a representative group of students and practising nurses. Conclusion
The development of a positive attitude and improvement of communication skills at the very beginning of the career pathway may lead to a situation where nurses have better soft skills and are more willing to develop these competences. The present results showing neutral attitudes of students towards developing communication skills and neutral self-assessment of
their competences confirmed the need to introduce communication issues into the curriculum for a nursing programme.
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The manuscript accepted for editing: 09.12.2017 The manuscript accepted for publication: 08.02.2018 Funding Sources: This study was not supported.
Conflict of interest: The authors have no conflict of interest to declare. Address for correspondence:
Lucyna Iwanow Żwirki i Wigury 61 02-091 Warszawa
phone: +48 22 57 20 490
e-mail: lucyna.iwanow@wum.edu.pl
Division of Teaching and Outcomes of Education, Faculty of Health Sciences, Medical University of Warsaw
